Rheumatoid Arthritis: Which Patients Do Best?

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

The Roles of Patient Knowledge
and Motivation, Compliance, and Self-Management in Outcome

Health care is an evolving art-science. Long gone are the days when patients
with chronic diseases simply arrive at a doctor's office and are told a
diagnosis, given a prescription, and asked to return in so many weeks or months
without any discussion or transmission of information about the pathophysiology
of the illness, treatment options, prognosis, or methods of monitoring for drug
toxicity. This is particularly true in the management of rheumatoid arthritis.

The optimal management of rheumatoid arthritis begins with patient education
about how the disease occurs and what damage it can cause, as well as an
overview of the symptoms, diagnosis, and treatment options. Consequently, there
are major advantages for patients who have the capability of understanding a
variety of new concepts and are motivated to participate in the treatment
decisions and monitoring of both the rheumatoid disease and for potential
toxicities of treatments.

Consistent with the concept of "better understanding of the illness leads to
better outcomes," research studies have documented better outcomes for those
patients with rheumatoid arthritis who come from higher socioeconomic
backgrounds. It is felt that patients who are better educated about the
rheumatoid condition are empowered to be more comfortable with confronting the
various methods of treating and monitoring the disease. Moreover, they will be
more motivated to monitor appropriately the consequences of treatments, such as
being obligated to regularly test their blood to be confident that toxicities
are detected early.